氯胺酮复合右美托咪定在小儿短小手术中的应用

Application of ketamine combined with dexmedetomidine in pediatric short operation

目的:研究氯胺酮复合右美托咪定在小儿短小手术麻醉中的麻醉效果和安全性。方法:选择美国麻醉学家协会(ASA)Ⅰ~Ⅱ级小儿非插管短小手术患儿60例,随机分为对照组(A组)、中剂量组(B组)和大剂量组(C组),每组20例。术中泵注不同剂量的右美托咪定至手术结束,并根据麻醉深浅间断静脉注射氯胺酮。持续监测心电图(ECG)、平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO_2)。记录术中追加氯胺酮剂量、术后清醒时间、Ramsay评分及各组术前、术后的血糖值。结果:三组患儿围手术期的SpO_2无明显变化;三组患儿t1较t0时刻的MAP、HR有所升高,但随右美托咪定剂量增加,升高幅度有所减少,与大剂量组相比,差异有统计学意义(P<0.05)。随着右美托咪定剂量的增加,围术期追加氯胺酮剂量明显减少,术前术后血糖变化幅度减少,与对照组相比,差异有统计学意义(P<0.05)。随DEX剂量增加,镇静程度增加,术后苏醒时间延长,与大剂量组相比,差异有统计学意义(P<0.05)。结论:以负荷量0.5μg/kg,维持量0.25μg·kg^(-1)·h^(-1)泵注右美托咪定在保证血流动力学相对平稳的情况下,减少术后躁动发生,无呼吸抑制,且对术后苏醒时间无明显影响,能够一定程度抑制手术应激,可安全用于小儿短小手术麻醉。

Objective： To study ketamine and dexmedetomidine given anesthesia and security in the short anesthesia in children. Methods： Selecting the 60 cases of non-intubation in pediatric surgery,the patients are American Society of Anesthesiologists（ ASA） Ⅰ ～ Ⅱ dividing into three groups randomly（ control group,low dose group,high dose group）,each group of20 cases. Continuous monitoring electrocardiogram（ ECG）,mean arterial pressure（ MAP）,heart rate（ HR） and pulse oximetry（ SpO2）. And recording intraoperative additional ketamine dose,postoperative awake time and sedation score（ using Ramsay sedation score）,and the preoperative and postoperative blood glucose values. Results： SpO2 did not change significantly in the three groups during the perioperative period; t1 in the three groups increased compared with MAP and HR at t0,but increased with the increase in dose of DEX,compared with the high-dose group. The difference was statistically significant（ P〈0. 05）. With the increase of dexmedetomidine dose,the dosage of ketamine was decreased and the change of blood glucose was decreased during the perioperative period,compared with the control group,the difference was statistically significant（ P〈0. 05）. With the increase of dexmedetomidine dose,the degree of sedation increased,and the postoperative awakening time prolonged,compared with the high dose group,the difference was statistically significant（ P〈0. 05）. Conclusion： With the load of 0. 5 μg/kg,the maintenance volume of 0. 25 μg·kg～（-1）·h～（-1） pumped dexmedetomidine in the case of ensuring a relatively stable hemodynamics can reduce hypothyroidism after the occurrence of restlessness,no respiratory depression,no significant effect on postoperative awakening time,inhibiting the surgical stress to a certain degree. In summary,the dose can be safe for children with short anesthesia.